Implementation of PEEPS in a Pediatric Acute Care Setting

CHEO is an acute care pediatric hospital located in Ottawa serving over 500,000 children and youth in Eastern and Northern Ontario, western Quebec, and Nunavut annually. The organization employs 3,200 doctors, nurses and allied health members, 250 researchers, 700 volunteers, and 2,300 student learners in medicine, nursing and other health professions. Staff at CHEO face significant delays in accessing resources to cope with workplace exposure to trauma, death, and moral distress. Mental health is the leading cause of all disability claims across all disciplines accounting for 38 percent of all CHEO claims. The CHEO Pulse Survey (2019) resulted in 62 percent (43 percent responded) of staff believing “we often work in crisis mode”. Critical Care Services Ontario (CCSO) conducted a 1-Measure Burnout Survey in summer 2019, which was distributed to critical care staff working in Ontario’s Hospitals. CHEO’s staff responses were above the provincial average. The Peer Emotional and Empowerment Program of Support (PEEPS) pilot targeted two specific clinical areas within the hospital in the Pediatric Intensive Care Unit (PICU) and Hematology-Oncology department, which includes an inpatient unit (4N), and Medical Day Unit (MDU). These areas collectively employ over 200 physicians, nurses, and respiratory therapists. These areas are very stressful, high paced, acute environments. 21 PEEPS facilitators were trained October 21-23rd, 2020 virtually via experts in Critical Incident Stress Management from Alberta Children’s Hospital. The facilitators work directly in the pilot areas in different disciplines.  PEEPS is offered as an on call service Monday to Friday from 0800h to 1600h. 
PEEPS was implemented November 2nd, 2020 improving access to emotional support for staff in the PICU and Hematology-Oncology programs. 35 interventions took place as individual (71 percent) or group (29 percent) supports, virtually or in person. 26 percent of interventions occurred outside of the pilot areas highlighting the need for program growth. A formal request for funding has been submitted for the expansion of PEEPS and further training of facilitators. Dedicated funds will promote successful implementation in other units and build on the momentum of the pilot project while aligning with CHEO’s commitment to staff wellness.

The primary goal of the Fellowship was to increase my knowledge about program implementation and subsequently implement the Peer Emotional Empowerment Program of Support (PEEPS) at the Children’s Hospital of Eastern Ontario (CHEO) in two clinical settings by November 30^th, 2020. The program had been pre-selected and pre-approved for pilot implementation through the foundational work of a prior RNAO Fellowship and in collaboration with the CHEO Debriefing Taskforce. Four specific learning objectives were outlined in the Fellow’s learning plan. My learning goals focused on establishing a solid foundation through the literature review process on program implementation in an acute care setting with the considerations in mind of change management and the program itself, rooted in Critical Incident Stress Management theories. My primary deliverable was to implement the pilot itself and learn and apply the principles of data collection that would allow for future program evaluation and growth. 

Through the activities outlined in my learning plan, as well as through the expertise of my mentorship team I was able to learn in depth the approaches to program implementation, but more notably program coordination. Throughout the Fellowship I was able to implement the pilot with my team and actively promote the program with confidence and knowledge to senior leaders across the hospital. I developed oral and written presentation skills including changing presentations and data provided based on the target audience’s needs and goals. I developed surveys allowing me to gain experience with coding and survey design management. Interpretation of these results were guided by my primary mentor Jennifer Ellis who allowed for my professional growth to occur as I gained more experience with interpreting survey results and survey design flaws. The Fellowship experience ultimately allowed me to gain critical leadership skills, effectively promote a new program and translate new knowledge to peers and senior leadership. As the program expands, I will be considered a subject matter expert along with my team Jeff Vidt and Brennah Holley to inform future practice updates and changes related to this program specifically. This knowledge and experience will translate to future opportunities in program implementation or assessment.